In this article, I argue that casebook photographs of the mentally ill can potentially move beyond a record of a clinical case, to bring into view an understanding of patients as individual subjects. My argument is based on an exploration of three selected photographs from the casebooks of the Grahamstown Lunatic Asylum, circa 1890s. Unlike the standard trope of casebook photographs – uniform mugshots that are archetypal images of classification, control and surveillance – the identified casebook photographs are characterised by a diversity of genre, style and origins. These elements all act upon the readings of the photographs, resulting in shifts in meaning and interpretation. For example, the photographs point to the prominence of aesthetic influences from broader visual culture such as portraiture and photograph albums. Accordingly, the photographs can be argued to accrue in meanings beyond any dominant clinical context or narrative. More importantly, what becomes comprehensible is that the interpretative context for the photographs is located precisely in terms of the individual sitters’ acts of posing, constructions of self-presentation and connections to socio-cultural worlds beyond the asylum.